Provider Demographics
NPI:1942470232
Name:PACIFIC MEDICAL REHABILITATION, PLLC
Entity Type:Organization
Organization Name:PACIFIC MEDICAL REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:YI
Authorized Official - Last Name:CUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-543-5250
Mailing Address - Street 1:PO BOX 30676
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98228-2676
Mailing Address - Country:US
Mailing Address - Phone:360-543-5250
Mailing Address - Fax:360-543-5251
Practice Address - Street 1:4540 CORDATA PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8059
Practice Address - Country:US
Practice Address - Phone:360-543-5250
Practice Address - Fax:360-543-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039814261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8288169Medicaid
WA8288169Medicaid